Abstract Body (Do not enter title and authors here): Background
Left ventricular global longitudinal strain (GLS) has been associated with mortality and heart failure hospitalization (HFH) among subjects with chronic heart failure, but not in patients with acute decompensated heart failure (ADHF). The study therefore investigated the prognostic role of GLS in the elder patients with ADHF and preserved left ventricular ejection fraction (LVEF).

Methods
Patients, aged≥ 65 years hospitalized for ADHF with LVEF ≥ 50% were enrolled in this study. Echocardiography was performed at discharge and after 6-month heart failure treatment. Post-discharge adverse events of cardiovascular death (CVD) and HFH were obtained. Subjects with adverse events during the 6-month treatment were excluded from this analysis.

Results
Among a total of 514 participants (82.6 ± 13.9 years, 50.6% men), 97 patients encountered CVD or HFH during a mean follow-up duration of 26.8 ± 11.6 months. The eventful subjects had a higher prevalence of diabetes, higher estimated pulmonary pressure, lower hemoglobin levels and was less on treatment with renin-angiotensin system inhibitors. The on-treatment GLS but not pre-discharge GLS was independently associated with adverse events after accounting for age, gender, diabetes, hemoglobin, renal failure, medications and echocardiographic indices [hazard ratio (HR) and 95% confidence intervals (CIs): 1.05, 1.01-1.09]. Additionally, the change in GLS from discharge to 6-month was also associated with adverse clinical outcomes (HR and 95% CIs: 1.05, 1.01-1.09).

Conclusions
The on-treatment GLS and the change in GLS, but not pre-discharge GLS were independently related to cardiovascular events in the elder patients with HF and preserved LVEF (HFpEF). This study highlights the importance timing to assess GLS among patients with decompensated HFpEF.